Healthcare Provider Details

I. General information

NPI: 1518495415
Provider Name (Legal Business Name): PBC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2017
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S RANCHO DR STE D1-A
LAS VEGAS NV
89106-3854
US

IV. Provider business mailing address

200 E KATELLA AVE STE C
ORANGE CA
92867-4805
US

V. Phone/Fax

Practice location:
  • Phone: 702-790-4404
  • Fax:
Mailing address:
  • Phone: 949-506-1300
  • Fax: 866-511-4654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BRENDA A BROWN
Title or Position: MANAGING MEMBER
Credential:
Phone: 949-506-1300